relevance of the expression “obs stable”: a retrospective study gregory scott academic clinical...
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Relevance of the expression “obs stable ” :
a retrospective study
Gregory Scott Academic clinical fellow
Roshan Vijayan Core surgical trainee
Pandora Male Medical student
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Obs stable
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Serious and important
BMJ
Seriousness
Quite silly and not important Christmas
BMJ
Importance
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Should we seriously worry about what we write?
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What’s wrong with “obs stable”?
1. “Stable” might be interpreted as “normal”
ButA patient with persistent tachycardia
has “stable” observations
2. “Obs stable” implies a lack of rigour
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What do we even mean by “stable”?
Current obs within “normal” range?
Variation in obs within “normal” limits (L) for a given time period (t)?
t
L
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Study• Objective: To ascertain whether use of the term “obs
stable” is so liberal as to render it meaningless.
• Design: Retrospective study
• Setting: Three London hospitals
• Methods– Searched notes for current admission of 46 randomly
selected inpatients for “obs stable” entries– Reviewed the nursing observations recorded during the
24 hours preceding each entry– Calculated for these 24 hour periods:
• Frequency of any abnormalities• Frequency of persistent abnormalities (occurring in every
observation)• Range (max.-min.) of observation values if at least two
observations had been recorded
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Results: “obs stable” occurrences
– 1+ “obs stable” entry in 36 (78%) notes
– 178 “obs stable” entries total (3.9 per
patient)
– 1st “obs stable” entry on day 2 (median)
– 3.9 nursing observations charted in the
24 hours before each entry (SD 1.4)
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Results: abnormalities in the 24 hours preceding “obs stable”
– 1+ abnormality in 113 (71%) of 159 cases• Tachypnoea (55%), hypotension (21%),
tachycardia (13%), desaturation (16%)
– 1+ one persistent abnormality in 31 (19%) cases
– Abnormality occurred in the observations immediately preceding an entry in 42% DefinitionsHypotension = SBP <100mmHg, Tachycardia = HR >100/minPyrexia = temperature >38C, Tachypnoea = RR≥20/minOxygen desaturation = saturations <95%
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Results: all “stable” observations
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Results: 24 hourly range of “stable” observations
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Discussion: findings
• Doctors regularly used the expression “obs stable”
• “Obs stable” was often associated with a 24 hour period which included abnormal observations
• In two fifths of cases, an abnormality occurred in the observations immediately preceding an “obs stable” entry
• The range of observations over a 24 hour period that were designated “stable” occasionally exceeded normal values of diurnal variation
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Discussion: limitations
• Small sample• No comparison with non-“stable” entries• Arbitrary definition of abnormalities• Arbitrary choice of 24 hour period• Difficult to define “normal” diurnal
variation
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Discussion: why do we write“obs stable”?
• Lack of time given to documentation• Intended to be less committal• Observation chart design• The patient seems well
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Conclusions
• The meaning of “obs stable” is ambiguous and does not always indicate normality.
• What could we write instead?–Write the observations in full – Qualify “obs stable” by adding “for the
last X hours” or– “Last abnormal observation was X
[observation] at Y [time]”• Perhaps obs stable has become ubiquitous
precisely because it of its ambiguity.
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Thank you
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